Provider Demographics
NPI:1790127108
Name:KANG, TAEKYOUNG (PT)
Entity type:Individual
Prefix:
First Name:TAEKYOUNG
Middle Name:
Last Name:KANG
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1248 REMINGTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4847
Mailing Address - Country:US
Mailing Address - Phone:224-230-9680
Mailing Address - Fax:224-255-4158
Practice Address - Street 1:1248 REMINGTON RD STE B
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-4847
Practice Address - Country:US
Practice Address - Phone:224-230-9680
Practice Address - Fax:224-255-4158
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070019141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist